Do I have symmastia? Are my breasts botched? (Photo)

Question

I had a dual plane 240 cc hp breast augmentation done almost exactly a year ago, and I don't feel too good about my breasts. My surgeon told me that I don't have symmastia, but is that really the case? My nipples were originally set far apart, so I guess there's not much that can be done about that besides downsizing? Or could the implants be set more far apart? I am very petite, but 240 cc is already so little... I was told that the implants are exactly as wide as my breast width

Semih Yildiz, MD, FEPOBRAS · Answer

In your photos, the implants sit close together medially and your nipples are naturally set wide apart, which was also visible in the preoperative photo. I do not see clear classic symmastia from the photos alone, meaning there is not an obvious loss of the normal breastbone attachment with one continuous pocket across the midline, but this can only be confirmed by an in-person exam.

This is not necessarily a “botched” result. The issue may be a mismatch between your natural nipple position, chest anatomy, implant width/profile, and pocket position. Moving implants farther apart can sometimes make the nipples look even more lateral, while moving them closer can risk true symmastia, so revision planning has to be very precise. If the medial pockets are too open or the implants are too wide for your frame, options may include pocket repair/capsulorrhaphy, changing implant dimensions, or sometimes downsizing, but the best choice depends on how the implants move when you lie down and whether the skin over the sternum remains firmly attached. A second opinion with a breast revision surgeon would be reasonable before deciding on surgery.

Brian K. Reedy, MD · Answer

Thanks for your question! It does appear as though you do have symmastia. While its a difficult cat to get back in the bag, it's not impossible. I would suggest an in-person consultation for the best recommendations. Good luck!

Bora Ok, MD · Answer

Hi from Istanbul, you do appear to have symmastia, sorry you're experiencing this problem. It's a complication that can occur after breast implant procedures (likely also influenced by the patient's anatomy) so it's more of a surgical complication rather than a botched result. But it can be addressed by creating a new breast implant pocket. I recommend getting a revision surgery. Best of luck to you!

Matthew C. Camp, MD · Answer

When implants are placed, the position of the nipple must be taken into account, such that the nipple is at the apex of the breast mound. In your case, the breast footprint has been violated, placing the implants too close to midline on the chest wall. This is fixable. The implants must be removed, the pocket closed down with sutures in the midline such that the breast is lateral to the sternum(chest bone). Smaller implants centered under the areolas would then be placed to restore a good aesthetic result.

Irena Karanetz, MD · Answer

Hello,
 
Thank you for the question.
 
Based on your photos, you do appear to have symmastia which can happen when both implants have been placed too close to each other and the tissue that separates them is stretched or merged. The skin lifts off the underlying sternum (breastbone). This causes a patient's breast to connect more in the midline than normally.

In order to correct symmastia, revision surgery can be performed using capsulorrhaphy technique with or without mesh reinforcement.  
 
I suggest that you seek an in person consultation with a Board-Certified Plastic Surgeon specializing in Breast Surgeries in order to discuss your goals and concerns for the best cosmetic results.  
I hope this helps.
 
Best regards,
 
Dr. Irena Karanetz
Breast Fellowship-Trained
Board Certified Plastic Surgeon

Jeffrey M. Darrow, MD · Answer

You are correct, in that your nipples were set far apart to begin with. However, when the implants were placed, they should’ve been placed so that the nipple is centered nearly at the midpoint of the implant on both a horizontal plane as well as a vertical plane.  You may not have the cleavage that you wanted, but you would not have ended up with your nipples appearing to be sitting very far out on your chest. A revision should be possible with this. Speak at length with your plastic surgeon. Best wishes.

Zoran Potparic, MD · Answer

In order to correct your symmastia deformity a separation of the breast implant pockets needs to be created using artificial mesh or patient own tissue. This will also require replacement of implants and possibly lateral expansion of implant envelope by means of capsulotomy. Smaller, narrow base implant should be considered. In person consultation with a board certified plastic surgeon with experience in this problem is recommended. Good luck.

Daniel Barrett, MD · Answer

Dear Dazzling197848,
symmastia is a rare breast condition that occurs when soft web-like breast tissue pulls breast implants towards each other, until the breasts meet uncomfortably at the center of the chest near the sternum (the body’s midline point). Given this abnormal union, symmastia is known by many other names, including breadloafing, kissing breast implants, and the uniboob.Unfortunately, this condition causes the surrounding skin and pectoral muscles to literally lift off the breast bone as the implants are pulled together. This consequently causes pain and discomfort, as well as obvious distortion of the breasts, which can only be disguised with clothing that does not show cleavage.You should consult with a board certified plastic surgeon for proper assessment. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Camille Cash, MD · Answer

From the photos it appears you would benefit from a revision.  The nipple position and shape can be improved. Different implants may be a better fit for you.  See a board certified plastic surgeon to discuss your concerns and learn more.

Connie Hiers, MD, FACS · Answer

If the fullness bothers you, then go down in size, maybe to 200 cc's, and go with a higher profile. You are not "botched" but do have some challenging anatomy issues.

Do I have symmastia? Are my breasts botched? (Photo)

Answers (12)

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